Cognitive and learning disorders

Cognitive function, also called cognitive performance or cognition, refers to the ability of an individual to think, process, and store information in order to solve problems.

Cognitive function, also
called cognitive performance or cognition, refers to the ability of an
individual to think, process, and store information in order to solve problems.
Humans are the only organisms capable of cognition.

Cognitive disorders are
characterized by delirium, dementia, and/or amnesia. Delirium is a term used to
describe a confused mental state in which a patient has difficulty processing
and interpreting information. Dementia is the loss of mental ability that is so
severe that it interferes with daily functioning. Amnesia may cause difficulty
remembering previously learned information. Patients with cognitive disorders
may experience one or more of these symptoms.

Treatment for cognitive
disorders depends on the underlying cause. Most disorders are incurable and
some may have devastating effects. For instance, Alzheimer's disease eventually
leads to complete cognitive impairment. Treatment may help delay progression of
such disorders. Other disorders, such as age-associated memory impairment
(AAMI) may only cause mild symptoms.

Cognitive learning
disabilities occur when individuals have difficulty interpreting or processing
what they see or hear. There is a gap between the patient's intelligence and
his/her ability to perform. Patients may have difficulties with spoken and
written language, self-control, coordination, and/or attention. As a result,
patients may have a hard time with schoolwork or performing tasks at work.

Patients with cognitive
learning disabilities are often able to live normal, healthy lives. There are
many ways for patients to cope with their disabilities. Special education and
adaptive skills training has been shown to improve patients' work and school
performances. Patients who are diagnosed and treated promptly are often able to
go to college and support themselves.

Age-associated memory impairment (AAMI): Age-associated
memory impairment (AAMI) refers to the normal decline in memory as patients
age. AAMI causes mild forgetfulness in patients who are older than 50 years of
age.

Alzheimer's disease: Alzheimer's disease (AD) is a
progressive cognitive disorder that causes dementia. Dementia is the loss of
mental ability that is so severe that it interferes with daily functioning.

Over many years, AD eventually leads to irreversible mental
impairment. During the final stages of AD, patients are unable remember,
reason, and learn new things.

AD typically develops in patients who are 65 years old or
older. Although doctors know that AD causes healthy brain tissue to slowly
degenerate over time, the exact origin of the disease remains unknown. Patients
with AD develop abnormal clumps (called plaques) and irregular knots of brain
cells (called tangles). Researchers believe that these clumps and tangles kill
brain cells and may eventually lead to AD. It has been suggested that genetics
may play a role in the development of plaques, which may lead to AD.

Inflammation of the brain has also been associated with AD.
However, researchers have not discovered if there is a relationship between
brain swelling and the development of AD.

There is currently no known cure for AD. Once diagnosed,
patients typically survive eight to 10 years with the disease. Some have been
known to live 25 years with the disease. In advanced Alzheimer's disease,
people may lose all ability to care for themselves. This can make them more
prone to additional health problems, such as pneumonia or malnutrition. They
may have difficulty swallowing food and liquids, which may cause individuals
with AD to inhale some of what they eat and drink into their airways and lungs,
which may then lead to pneumonia.

Brain injury: Trauma to the head may damage brain cells and
lead to cognitive dysfunction. Brain trauma can result from accidents (such as
motor vehicle wrecks and falls), assaults (such as gunshot wounds or beatings),
or from sports activities (such as boxing and football) without adequate
protective gear. In some cases, injury may still result even if protective gear
is worn.

Dementia caused as a result of trauma can be permanent or
temporary, depending on the extent of the damage and the ability of the
individual's brain to recover.

Infections of brain structures, such as meningitis
(inflammation of the protective membranes in the brain) and encephalitis
(inflammation of the brain), are primary causes of dementia. Other infections,
such as human immunodeficiency virus (HIV) and syphilis (a bacterial sexually
transmitted disease), can affect the brain in later stages. In all cases,
inflammation in the brain damages cells. Damage to memory due to infection can
be permanent or temporary, depending on the extent of the damage and the
brain's ability to recover.

Niacin deficiency-induced dementia: Dementia can be caused
by severe niacin insufficiency, a condition called pellagra. Niacin is a
B-complex vitamin found in a many foods such as liver, poultry, fish, nuts, and
dried beans.

Pellagra-induced dementia is uncommon in developed
countries, such as the United States. It is most common in areas of the world
where malnutrition is prevalent.

Multi-infarct disease: Multi-infarct disease is the second
most common cause of irreversible dementia. The condition occurs when the blood
flow to the brain is disrupted. If the brain does not receive enough blood,
then it is starved of oxygen, and permanent brain damage may result.

In multi-infarct disease, multiple strokes lead to a
progressive decline in cognition. Strokes cause neurological damage in the
brain due to a lack of oxygen.

Multiple infarct dementia is more common in men who are
older than 50 years of age. A person with this condition may also experience
motor weakness, urinary incontinence, and ataxia (irregular muscle
coordination). Patients may also develop high blood pressure, diabetes, or
vascular disease.

Learning disabilities: Learning disabilities are disorders
that occur when patients have difficulty interpreting or processing what they
see or hear. There is a gap between the patient's intelligence and his/her
performance in school, work, or other areas of life.

Patients may have difficulties with spoken and written
language, self-control, coordination, and/or attention. As a result, patients
may have a hard time with schoolwork or performing tasks at work.

Learning disabilities may be lifelong. In some cases, they
may affect many areas of a person's life, including academics, work, social
life, or daily routines. Some patients may have several different disabilities.
Others may have only one problem that has little or no impact on their lives.

It is important to note that not all learning problems are
learning disabilities or cognitive deficits. Some children are simply slower
than others in developing new skills. In some cases, learning disabilities may
be mistakenly suspected when a child is simply slower to mature.

Learning disabilities occur when certain areas of the brain
do not function properly. Many factors, including genetics, may be involved in
the development of learning disabilities.

In the past, intellectual disability was commonly called
mental retardation. However, the term, "mental retardation," has
acquired a negative social stigma over the years. Therefore, doctors and other
professionals have begun to replace the term with intellectual disability.

There is significant variation in the signs and symptoms of
intellectual disabilities. Some patients may be able to live relatively normal
lives with minimal assistance, while others may require 24-hour assistance with
everyday tasks.

There are many potential causes of intellectual
disabilities, including genetics, problems during pregnancy (e.g. infection or
a mother who drinks or uses drugs during pregnancy), the baby not getting
enough oxygen during delivery, and exposure to disease (e.g. whooping cough,
measles, or meningitis). Doctors are only able to identify a cause of
intellectual disability in about 30% of patients.

General: The signs and symptoms of cognitive disorders and
cognitive learning disabilities vary, depending on the type and severity of the
condition. Some patients may live normal, healthy lives and are barely affected
by the disorder. Other may have severe disabilities that limit their abilities
to function independently.

Age-associated memory impairment (AAMI): Age-associated
memory impairment (AAMI) causes mild forgetfulness in patients who are 50 years
old or older.

Alzheimer's disease: Symptoms of Alzheimer's disease (AD)
typically develop in patients who are 65 years old and older. However, a less
common form of AD, known as early-onset AD, may develop in patients who are
30-40 years old. The youngest patient to be diagnosed with AD was 29 years old.

At first, symptoms may be mistaken for normal forgetfulness.
However, overtime, the patient loses all cognitive functioning.

Mild symptoms may include memory impairment, confusion,
difficulty learning and remembering new information, difficulty with daily
tasks, mood swings, restlessness, and depression. In most cases, the patient is
still able to do most activities, such as driving a car. However, the patient
may get lost going to familiar places.

Moderate symptoms may include forgetting old facts,
continually repeating stories, and/or asking the same questions repeatedly. The
individual may make up stories to fill memory gaps. Patients have difficulty
performing everyday tasks, such as keeping a checkbook, shopping for groceries,
or following written notes. Patients may need help performing daily activities.
Other symptoms may include agitation, restlessness, repetitive movement,
paranoia, delusions, and hallucinations. Deficiencies in intellect and
reasoning, along with a lack of concern for appearance, hygiene, and sleep,
become more noticeable.

In the advanced stage of AD, damage to the brain's nerve
cells is widespread. At this point, full-time care is typically required. The
patient is generally bedridden. For friends, family, and caregivers, this can
be the most difficult stage. Individuals with severe Alzheimer's disease may
have difficulty walking, and they often suffer complications from other
illnesses such as pneumonia. Signs of severe Alzheimer's disease may include
groaning, screaming, mumbling, or speaking incoherently. They refuse to eat and
may inappropriately cry out. Individuals with severe or advanced symptoms fail
to recognize the faces of family members or caregivers. Apraxia (inability to
perform physical tasks such as dressing or eating) and aphasia (loss of ability
in comprehension of spoken or written language) are seen. They have great
difficulty with all essential activities of daily life.

Multi-infarct disease: Memory impairment is often the first
symptom to be noticed. An individual with dementia may be unable to remember
ordinary information, such as his/her birth date, phone number, and address.
Patients may be unable to recognize friends and family members. There is a progressive
decline in cognitive function, including decision making, judgment, orientation
in time and space, problem solving, and verbal communication. Behavioral
changes may be seen in eating, dressing, and using the bathroom. Dementia
patients may be unable to dress without help and may become incontinent or lose
the ability to control urine flow. Normal interests, such as hobbies and social
groups, are abandoned. They are unable to perform routine activities, such as
driving, grocery shopping, and housecleaning. Individuals with dementia also
experience changes in personality, such as inappropriate responses and lack of
emotional control.

Trauma may cause prolonged or permanent changes in
cognition, memory, emotions, or behavior.

Niacin deficiency-induced dementia: Patients with Niacin
deficiency-induced dementia may suffer from the same symptoms as patients with
multi-infarct disease.

In addition, niacin deficiency may cause symptoms that
affect other parts of the body. Other symptoms, unrelated to dementia, may
include skin lesions, inflammation of the tongue, reddening of the tongue, pain
in the mouth, increased salivation, ulcerations in the mouth, burning in the
throat, swelling in the abdomen, abdominal pain, constipation, diarrhea,
nausea, and vomiting.

Learning disabilities: Cognitive learning disabilities vary
from mild to severe. There are several different types of learning
disabilities, including dyslexia, dysgraphia, dyscalculia, dyspraxia, and
auditory perceptual deficit.

Dyslexia occurs when patients have difficulty translating
written images into meaningful language. Patients may be unable to recognize
written letters or words. Some may be reading at grade levels far below
average.

Dysgraphia occurs when patients have difficulty writing
letters within a defined space. Patients may take longer to write and have
extremely poor handwriting that is almost illegible.

Patients with dyspraxia have poor motor control of large
movements. Patients may have poor balance, poor posture, lack of rhythm when
dancing, poor hand-eye coordination, and clumsy movement.

Visual perceptual deficit occurs when patients have
difficulty processing visual information. Although nothing may be wrong with
their eyesight, patients may have difficulty identifying an object from a
background of other objects or they may not see things in the proper order.

Auditory perceptual deficit occurs when patients have
difficulty processing auditory information. Although nothing may be wrong with
their hearing, the brain does not interpret sounds properly. As a result,
patients may have difficulty understanding and remembering things that are
said. They may have difficulty distinguishing between similar sounds or hearing
one sound over background noise.

Intellectual disability (mental retardation): Patients with
mild intellectual disabilities have intelligence quotients (IQs) of 52-69. From
birth to age six, patients are able to develop social and communication skills,
but motor coordination is slightly impaired. By late adolescence, patients are
able to learn until about a six-grade level. They are generally able to learn
appropriate social skills. Adults are usually able to work and support
themselves. Some patients may need help during times of social or financial
stress.

Patients with moderate intellectual disabilities have IQs of
36-51. Children younger than six years old are able talk or communicate with
others, but social awareness is generally poor. The patient's motor
coordination is typically fair. Adolescents are able to learn some occupational
and social skills. They may be able to learn how to travel alone in familiar
places. Adults may be able to support themselves with a job. They usually
require guidance and assistance during mild social or financial stress.

Patients with severe intellectual disabilities have IQs of
20-35. Young children can say a few words, but their speech is limited. Motor
coordination is generally poor. Adolescents can usually talk or communicate
with others. They are able to learn simple habits. Adults typically require
lifelong assistance and guidance with daily activities.

Patients with profound intellectual disabilities have IQs of
19 or lower. Children younger than six years old have very little motor
coordination and may require nursing care. Adolescents typically have limited
motor and communication skills. Adults usually require lifelong nursing care.

Depression: Depression is common in patients with
Alzheimer's disease (AD), especially during the earlier stages when they may be
aware of losing mental functions. Depression may be treated with medications
called antidepressants.

Falls and their complications: Individuals who suffer from dementia
may become disoriented, increasing their risk of falls. Falls can lead to bone
fractures that require hospitalization, medications, and surgery. Falls may
also lead to an increase in the severity of AD symptoms, such as confusion and
agitation. In addition, falls are a common cause of serious head injuries, such
as brain hemorrhage (bleeding in the brain). Long-term immobilization after
surgery and hospitalization may increase the risk of a pulmonary embolism
(blood clot in the lungs), which can be life-threatening.

Infections: In severe and advanced dementia, individuals may
lose all ability to care for themselves. This can make them more prone to
additional health problems including pneumonia, which is an infection of the
lungs and respiratory system. The individual may have difficulty swallowing
food and liquids, which may cause them to inhale some of what they eat and
drink into their airways and lungs, which may lead to pneumonia.

Urinary incontinence: Patients with severe or advanced
dementia may develop urinary incontinence or the loss of bladder control that
causes urine leakage. These patients may require the placement of a urinary
catheter, which increases the risk of urinary tract infections (UTIs). UTIs can
lead to more serious, life-threatening infections, such as pyelonephritis
(bacterial infection of the kidney).

Age-associated memory impairment (AAMI): There are currently
no tests to diagnose age-associated memory impairment (AAMI). However, if
symptoms of forgetfulness worsen over time, patients should be tested for
Alzheimer's disease (AD) or other cognitive disorders.

Alzheimer's disease: The earliest reported Alzheimer's
disease diagnosis purportedly occurred in a 29-year-old patient. However, most
patients are diagnosed with the condition when they are older than 65 years of
age. There is no one test to diagnose Alzheimer's disease (AD). Typically,
doctors start the diagnostic process by ruling out other diseases and
conditions, such as brain injury or stroke, which may also cause memory loss.

A Mental Status Evaluation (MSE) screens memory,
problem-solving abilities, attention spans, counting skills, and language
skills. Questions such as "what day is it today?" or "who is the
president of the United States?" may be asked. Recall tests are another
example. Doctors may list familiar objects and then ask a person to repeat them
immediately and again five minutes later. The Clock Drawing Test, the
Mini-Mental State Examination (MMSE), and the Functional Assessment Staging
(FAST) are commonly used mental status evaluation tools for determining if AD
is present. On the tests, the final score helps confirm a diagnosis of AD

Brain scans may also be used to take pictures of the brain.
Images of the brain are then analyzed for changes in function and structure of
the brain that are associated with AD. Researchers have performed studies to
determine if these brain scans may help predict a person's risk of developing
the condition.

Multi-infarct dementia: The American Psychiatric Association
has established two generally accepted criteria for the diagnosis of dementia:
(1) a decline in recent and past memory and (2) impairment of one or more of
the following functions: language (aphasia or the misuse of words or inability
to remember and use words correctly); motor activity (apraxia or unable to
perform motor activities even though physical ability remains intact);
recognition (agnosia or unable to recognize objects, even though sensory
function is intact); and executive function (unable to plan, organize, and
think abstractly). Symptoms often develop gradually and show a progressive deterioration
in function.

Once dementia is diagnosed, brain scans may be performed to
detect possible abnormalities in the brain.

Niacin deficiency-induced dementia: If a patient meets the
diagnostic criteria for dementia, additional tests are performed to determine
the cause. A blood test is performed to determine if a niacin deficiency is the
cause. Patients with dementia that is caused by niacin deficiency will have low
levels of niacin in the blood. Healthy individuals typically have 2.4-6.1
milligrams of niacin per deciliter of blood.

Learning disabilities: Prompt diagnosis and early treatment
of learning disabilities has been shown to improve a patient's long-term
prognosis. In order to diagnose a learning disability, a specialist will
administer several tests, which may involve writing, speaking, and listening.
These tests are designed to measure the patient's strengths and weaknesses. In
addition, the specialist will interview the patient and family members about
medical history and problems that are being encountered.

Intellectual disability (mental retardation): Even though
intellectual disability (mental retardation) is an irreversible condition,
early diagnosis and prompt treatment has been shown to help improve patients'
long-term prognoses.

Doctors diagnose intellectual disability after a medical
history, physical examination, and intellectual quotient (IQ) test. If a
patient does not show signs of adaptive behavior and scores well below average
on the IQ test, then a positive diagnosis is made. To measure the patient's
adaptive behavior professionals will compare what the patient can do to other
children of his or her age. Many skills, including daily living skills (e.g.
getting dressed, feeding oneself, and using the bathroom), communication skills
(understanding what is being said and being able to respond), and social skills
are important to adaptive behavior.

Patients with mild intellectual disabilities have
intelligence quotients (IQs) of 52-69. Patients with moderate intellectual
disabilities have IQs of 36-51. Patients with severe intellectual disabilities
have IQs of 20-35. Patients with profound intellectual disabilities have IQs of
19 or lower.

Cholinesterase inhibitors: The U.S. Food and Drug
Administration (FDA) has approved cholinesterase inhibitors for the treatment
of Alzheimer's disease (AD). These drugs are also used to treat other types of
permanent dementia, including multi-infarct dementia. Cholinesterase inhibitors
increase the amount of a neurotransmitter, called acetylcholine, throughout the
body. Acetylcholine is a chemical that carries messages between the nerves and
muscles, and it appears to be involved in learning and memory. Patients with AD
have low levels of acetylcholine. Commonly prescribed medications include
donepezil (Ariceptï¿½), rivastigmine (Exelonï¿½), and galantamine
(Razadyneï¿½). About half of the people who take cholinesterase inhibitors
experience a modest improvement in cognitive symptoms, such as memory.

Side effects are common and may include diarrhea, dizziness,
drowsiness, fatigue, nausea, and vomiting. These side effects may cause some
patients to discontinue medications. Individuals with liver disease, peptic
ulcer disease, chronic obstructive pulmonary disease (COPD), and slow heart
rate should not take these drugs.

Memantine: Memantine (Namendaï¿½) is a drug approved by the
FDA for treatment of moderate to severe Alzheimer's disease. Memantine is also
used to treat other types of permanent dementia, including multi-infarct
dementia. Memantine, an NMDA (N-methyl-D-aspartate) receptor antagonist, is the
first AD drug of its kind that has been approved in the United States. It
appears to work by regulating the activity of glutamate, which is one of the
brain's specialized messenger chemicals involved in information processing,
storage, and retrieval. Glutamate plays an essential role in learning and
memory. Excess glutamate, on the other hand, may lead to disruption and death
of brain cells. Memantine may protect cells against excess glutamate by
partially blocking NMDA receptors. Side effects include headache, constipation,
confusion, and dizziness.

Nicotinamide supplements: Patients who develop dementia as a
result of niacin deficiency receive nicotinamide supplements (e.g. Advicorï¿½,
Niacorï¿½, or Niaspanï¿½). Since the supplement is made from niacin, it helps
the patient return to normal niacin levels in the body. Nicotinamide
supplements effectively cures dementia in these patients.

Long-term care: An individual with dementia may need monitoring
and assistance at home or in an institution. Options include in-home care,
boarding homes, adult daycare, and convalescent or long-term care facilities
(nursing homes).

Visiting nurses, volunteer services, homemakers, adult
protective services, and other community resources may help a family care for a
patient with dementia. In some communities, support groups may be available.
Family counseling may also help relatives of the patient cope with homecare and
the debilitating effects of cognitive disorders.

The patient should be surrounded with familiar objects and
people. Leaving the lights on at night may help reduce or prevent episodes of
disorientation. Patients should follow simple schedules that are easy to
remember.

Behavior modification may be beneficial in patients who
exhibit unacceptable or dangerous behavior. This type of therapy involves
rewarding appropriate behaviors and ignoring inappropriate ones (when it is
safe to do so). Reality orientation is a technique in which caretakers take
every opportunity to orientate the patient, such as reminding the patient where
they are and what time of day it is. Reality orientation with repeated
reinforcement of environmental and other cues may also help reduce
disorientation.

Patients who are diagnosed with a progressive form of
dementia, such as AD, should seek legal advice before they are unable to make
decisions about medical care and end-of-life issues.

General: Patients with cognitive learning disabilities are
often able to live normal, healthy lives. There are many ways for patients to
cope with their disabilities. Special education and adaptive skills training
has been shown to improve patients' work and school performances. Patients who
are diagnosed and treated promptly are often able to go to college and support
themselves.

Education: Patients with learning disabilities or
intellectual disabilities must have the option of receiving education that is
tailored to their specific strengths and weaknesses. According to the
Individuals with Disabilities Education Act, all children with disabilities
must receive free and appropriate education. According to the law, members of
the patient's school should consult with the patient's parents or caregivers to
design and write an individualized education plan. Once all parties agree with
the plan, the educational program should be started. The school faculty should
document the child's progress in order to ensure that the child's needs are
being met.

Educational programs vary among patients. In general, most
experts believe that children with disabilities should be educated alongside
their non-disabled peers. The idea is that non-disabled students will help the
patient learn appropriate behavioral, social, and language skills. Therefore,
some patients are educated in mainstream classrooms. Other patients attend
public schools but take special education classes. If the disability is severe
or profound, then patients may benefit from specialized schools that are
designed to teach children with disabilities.

Adaptive skills training: Many patients with intellectual
disabilities (mental retardation) need help improving their adaptive skills,
which are needed to live, work, and function in the community. Teachers,
parents, and caregivers can help patients work on their daily living skills,
communication skills, and social skills.

Caregivers, friends, and family members of patients who have
cognitive disorders or learning disabilities should educate themselves about
the condition. The more a caregiver or loved one knows about the condition, the
better they can help the patient. Being educated on the disorder or disability
may also help the caregiver learn how to communicate better with the patient.

Caregivers may find support from other families who are
caring for patients with cognitive disorders. Many communities have local
support groups for parents, family members, and caregivers of patients with
cognitive disorders.

Parents of children with learning disabilities or
intellectual disabilities should stay in close contact with their children's
teachers. This helps ensure that the child is receiving appropriate education
that is tailored to his/her specific needs. Parents are also encouraged to find
out how they can support their children's learning needs at home.

Ginkgo: Ginkgo biloba has been used medicinally for
thousands of years. The scientific literature overall does suggest that ginkgo
may benefit people with dementia (multi-infarct and Alzheimer's type), and may
be as helpful as acetylcholinesterase inhibitor drugs such as donepezil
(Ariceptï¿½). Well-designed research comparing ginkgo to prescription drug
therapies is needed.

Avoid if allergic or hypersensitive to members of the
Ginkgoaceae family. If allergic to mango rind, sumac, poison ivy or oak or
cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like
aspirin or warfarin (Coumadinï¿½)) due to an increased risk of bleeding. Ginkgo
should be stopped two weeks before surgical procedures. Ginkgo seeds are
dangerous and should be avoided. Skin irritation and itching may also occur due
to ginkgo allergies. Ginkgo should not be used in supplemental doses if
pregnant or breastfeeding.

Sage: Sage has long been suggested as a possible therapy for
memory and cognitive improvement. Several trials provide evidence for the use
of sage for this indication. Additional study is needed to confirm these
findings and determine the best dose.

Avoid if allergic or hypersensitive to sage species, their
constituents, or to members of the Lamiaceae (mint) family. Use cautiously with
hypertension (high blood pressure). Use sage essential oil or tincture
cautiously in patients with epilepsy. Avoid if pregnant or breastfeeding.

Good scientific evidence:

Aromatherapy: Aromatherapy is the use of essential oils from
plants for healing purposes. There is suggestive preliminary evidence that
aromatherapy using essential oil of lemon balm (Melissa officinalis) may
effectively reduce severe agitation in dementia when applied to the face and
arms twice daily. Other research reports that steam inhalation of lavender
aromatherapy may have similar effects. However, there is a conflicting study
that reports no benefits of aromatherapy using lemon balm, Lavender
officinalis, sweet orange (Citrus aurantium), or tea tree oil (Malaleuca
alternifolia). Overall, the evidence does suggest potential benefits. It is not
clear if this is because of anxiety-reducing qualities of these therapies.
Additional study is necessary. There is also preliminary research suggesting
that aromatherapy used with massage may help to calm people with dementias who
are agitated. However, it is not clear if this approach is any better than
massage used alone.

Essential oils should be administered in a carrier oil to
avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if
driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct
contact of undiluted oils with mucous membranes. Use cautiously if pregnant.

Bacopa: Bacopa monnieri leaf extract is called brahmi in
Ayurvedic medicine (medicine practiced in India) and is widely used in India
for enhancing memory, pain relief, and treating epilepsy. Although bacopa is
traditionally used in Ayurvedic medicine to enhance cognition, high-quality
clinical trials are lacking. Two methodologically weak studies found some
evidence that bacopa improves cognition. However, more high-quality and
independent research is needed before bacopa can be recommended for enhancing
brain function in adults or children.

Bacopa may interact with medications such as calcium channel
blockers (used for arrhythmias and high blood pressure), thyroid medications,
phenytoin (Dilantinï¿½), and drugs metabolized by the liver. Use cautiously
with drugs or herbs that are metabolized by cytochrome P450 enzymes, thyroid
drugs, calcium blocking drugs, and sedatives. Avoid if allergic/hypersensitive
to Bacopa monnieri, its constituents or any member of the Srcophulariaceae
(figwort) family. Avoid if pregnant or breastfeeding.

Ginkgo: Multiple clinical trials have evaluated ginkgo for a
syndrome called cerebral insufficiency. This condition, more commonly diagnosed
in Europe than the United States, may include poor concentration, confusion,
absent-mindedness, decreased physical performance, fatigue, headache,
dizziness, depression, and anxiety. It is believed that cerebral insufficiency
is caused by decreased blood flow to the brain due to clogged blood vessels.
Some studies report benefits of ginkgo in patients with these symptoms, but
most have been poorly designed without reliable results. Better studies are
needed before a conclusion can be made.

Avoid if allergic or hypersensitive to members of the
Ginkgoaceae family. If allergic to mango rind, sumac, poison ivy or oak or
cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like
aspirin or warfarin (Coumadinï¿½)) due to an increased risk of bleeding. Ginkgo
should be stopped two weeks before surgical procedures. Ginkgo seeds are
dangerous and should be avoided. Skin irritation and itching may also occur due
to ginkgo allergies. Ginkgo should not be used in supplemental doses if
pregnant or breastfeeding.

Music therapy: Music is used to influence physical,
emotional, cognitive and social well-being and improve quality of life for
healthy people as well as those who are disabled or ill. It may involve either
listening to or performing music, with or without the presence of a music
therapist. In people with Alzheimer's dementia and other mental disorders in
older adults, music therapy has been found to reduce aggressive or agitated
behavior, improve mood, and improve cooperation with daily tasks such as
bathing. Music therapy may also be beneficial for dementia-associated
neuropsychiatric symptoms, such as depression and aggressive behavior.
Additionally, music therapy may help maintain mental performance in elderly
adults undergoing surgical procedures, reduce postoperative confusion and
delirium, and increase energy levels. Music therapy is generally known to be
safe.

Sage: Alzheimer's disease is characterized by memory loss
that interferes with social and occupational functioning. Early evidence
suggests that sage oil may be useful in the treatment of Alzheimer's disease.

Avoid if allergic or hypersensitive to sage species, their
constituents, or to members of the Lamiaceae family. Use cautiously with
hypertension (high blood pressure). Use the essential oil or tinctures
cautiously in patients with epilepsy. Avoid with previous anaphylactic
reactions to sage species, their constituents, or to members of the Lamiaceae
family. Avoid if pregnant or breastfeeding.

Unclear or conflicting scientific evidence:

Acupressure, shiatsu: Acupressure may decrease verbal and
physical agitated behavior in dementia patients. Further study is needed before
a conclusion can be made.

With proper training, acupressure appears to be safe if
self-administered or administered by an experienced therapist. Serious
long-term complications have not been reported, according to scientific data.
Hand nerve injury and herpes zoster ("shingles") cases have been
reported after shiatsu massage. Forceful acupressure may cause bruising.

Acupuncture: Acupuncture has been reported to help improve
memory and cognitive performance in the elderly. However, there is currently
insufficient available evidence for the use of acupuncture in cognitive
disorders and communication disorders. There is also insufficient evidence to
recommend the use of acupuncture in the treatment of vascular dementia. More
research is necessary.

Needles must be sterile in order to avoid disease
transmission. Avoid with valvular heart disease, infections, bleeding disorders
or with drugs that increase the risk of bleeding (anticoagulants), medical
conditions of unknown origin, and neurological disorders. Avoid on areas that
have received radiation therapy and during pregnancy. Use cautiously with
pulmonary disease (like asthma or emphysema). Use cautiously in elderly or
medically compromised patients, diabetics, or with a history of seizures. Avoid
electroacupuncture with arrhythmia (irregular heartbeat) or in patients with
pacemakers.

Applied kinesiology: Applied Kinesiology (AK) is an
assessment technique that uses muscle strength testing with the aim to identify
nutritional deficiencies and health problems. It is based on the concept that
weakness in certain muscles correspond to specific disease states or body
imbalances. Applied Kinesiology, when used along with physical manipulation,
massage, homeopathy, herbal remedies, and neuro-linguistic programming, showed
some positive results in dyslexic children; however the effect of Applied
Kinesiology alone for dyslexia cannot be isolated from the other therapies.

Applied kinesiology techniques in themselves are considered
to be harmless. However, medical conditions should not be treated with AK
alone, and should not delay appropriate medical treatment.

Arginine: There is not enough information available to make
a strong recommendation about the use of the amino acid arginine in senile
dementia.

Avoid if allergic to arginine, or with a history of stroke,
or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if
taking blood-thinning drugs (like warfarin or Coumadinï¿½) and blood pressure
drugs or herbs or supplements with similar effects. Check blood potassium
levels. L-arginine may worsen symptoms of sickle cell disease. Caution is
advised in patients taking prescription drugs to control sugar levels.

Art therapy: Art therapy enables the expression of inner
thoughts or feelings when verbalization is difficult or not possible. The
aesthetic aspect of the creation of art is thought to lift one's mood, boost self-awareness,
and improve self-esteem. Art therapy also allows the opportunity to exercise
the eyes and hands, improve eye-hand coordination, and stimulate neurological
pathways from the brain to the hands. Art therapy may be an effective means of
improving quality of life in the elderly. Art therapy has been used in only a
few studies with Alzheimer's disease (AD) patients, with some suggestion of
benefit in alleviating negative emotions and minimizing problematic behaviors.
However, further studies are needed for definitive conclusions. There is
evidence that the non-directed use of visual art (pictures) as a means of
encouraging communication among elderly nursing home residents may increase
well-being. It may also reduce blood pressure and improve medical health status
with regard to reported dizziness, fatigue, pain, and use of laxatives.

Art therapy may evoke distressing thoughts or feelings. Use
under the guidance of a qualified art therapist or other mental health
professional. Some forms of art therapy use potentially harmful materials. Only
materials known to be safe should be used. Related clean-up materials (like
turpentine or mineral spirits) that release potentially toxic fumes should only
be used with good ventilation.

Astragalus: In traditional Chinese medicine (TCM),
astragalus is commonly found in mixtures with other herbs. Based on human
study, astragalus may help improve mental performance of children with low
intelligence quotients (IQs). This study, however, used astragalus as part of a
combination therapy, and it is difficult to ascribe the effects to any one
constituent. Further, well-designed clinical trials are required before
recommendations can be made.

Avoid if allergic to astragalus, peas, or any other related
plants. Avoid with a history of Quillaja bark-induced asthma. Avoid if taking
anticoagulants (e.g. warfarin or aspirin) or herbs or supplements with similar
effects. Avoid with inflammation, fever, stroke, organ transplantation, or
autoimmune diseases. Stop use two weeks before and immediately after surgery,
dental, or diagnostic procedures that have bleeding risks. Use cautiously with
bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney
disorders. Use cautiously if taking blood-thinners, blood sugar drugs,
diuretics, herbs or supplements with similar effects. Avoid if pregnant or
breastfeeding.

Ayurveda: The herb Brahmi (Bacopa monnieri) is used in many
Ayurvedic preparations for a variety of ailments. There is evidence from
well-designed studies that it may improve memory and cognitive function in
adults. Another study suggests that the herbal preparation Maharishi Amrit
Kalash (MAK) -4 may enhance attention capacity or alertness, and thus reverse
some of the detrimental cognitive effects of aging. Further research is needed
to confirm these results.

Ayurvedic herbs should be used cautiously because they are
potent and some constituents can be potentially toxic if taken in large amounts
or for a long period of time. Some herbs imported from India have been reported
to contain high levels of toxic metals. Ayurvedic herbs may interact with other
herbs, foods, and drugs. A qualified healthcare professional should be
consulted before use. Use guggul cautiously with peptic ulcer disease. Patients
should avoid sour food, alcohol, and heavy exercise with use of this herb.
Mahayograj guggul should not be taken for long periods of time. Pippali (Piper
longum) should be taken with milk and avoided with asthma. Avoid sweet flag,
and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia chebula
(harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain,
advanced disease stages and medical conditions that require surgery.

Bacopa: Bacopa monnieri leaf extract is called brahmi in
Ayurvedic medicine and is widely used in India for enhancing memory, pain
relief, and treating epilepsy. However, additional study is needed before a
firm conclusion can be drawn.

Bacopa may interact with medications such as calcium channel
blockers (used for arrhythmias and high blood pressure), thyroid medications,
phenytoin (Dilantinï¿½), and drugs metabolized by the liver. Use cautiously
with drugs or herbs that are metabolized by cytochrome P450 enzymes, thyroid
drugs, calcium blocking drugs, and sedatives. Avoid if allergic/hypersensitive
to Bacopa monnieri, its constituents, or any member of the Srcophulariaceae
(figwort) family. Avoid if pregnant or breastfeeding.

Beta-carotene: Antioxidants such as beta-carotene may be
helpful for increasing cognitive performance and memory. Long-term, but not
short-term, beta-carotene supplementation appears to benefit cognition.

Avoid if sensitive to beta-carotene, vitamin A,
or any other ingredients in beta-carotene products.

Mental fitness: Maintaining mental fitness may delay onset
of dementia. Some researchers believe that lifelong mental exercises and
learning may promote the growth of additional synapses, the connections between
neurons, and delay the onset of dementia. Other researchers argue that advanced
education gives a person more experience with the types of memory and thinking
tests used to measure dementia. Doing crossword puzzles, reading books, and
increasing social activities are recommended by healthcare providers.

Lifestyle: Lifestyle habits that can reduce the risk for
head injury include using seat belts, wearing a helmet when riding bicycles and
motorcycles, and wearing protective headgear when playing contact sports.
Avoiding substance abuse and addiction can reduce the risk for dementia
resulting from disease, vitamin deficiency, seizure, and head injury. Safer sex
practices can help prevent human immunodeficiency virus (HIV) and syphilis
infection, reducing the risk for acquired immunodeficiency syndrome (AIDS)
dementia complex and neurosyphilis dementia. The risk for dementia as a result
of other metabolic or toxic conditions can be reduced by receiving prompt
medical attention at the first sign of illness (such as fever, pain, swelling,
heat, confusion, or other impairment of cognitive function).

Heart health: Some of the most recent research indicates
that taking steps to improve cardiovascular (heart) health, such as losing
weight, exercising, and controlling high blood pressure and high cholesterol,
may also help prevent dementia and Alzheimer's disease. A clinical study found
that individuals with mild to severe Alzheimer's disease placed on a simple
exercise program (one hour, twice a week) had a significantly slower cognitive
decline than those on routine medical care.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Several
clinical studies have reported that the NSAIDs ibuprofen (Advilï¿½ or
Motrinï¿½), naproxen sodium (Aleveï¿½), and indomethacin (Indocinï¿½, a
prescription drug) may reduce the risk of developing Alzheimer's disease. This
may be because inflammation appears to play a role in Alzheimer's. Because
NSAIDs can cause stomach and intestinal bleeding and kidney problems, clinical
trials need to be completed before it is clear whether individuals should take
NSAIDs solely to prevent Alzheimer's. Patients should not take NSAIDs regularly
unless they consult their healthcare providers.

Statin drugs: Statin drugs are used to lower cholesterol
levels. They include atorvastatin (Lipitorï¿½) and simvastatin (Zocorï¿½).
Recent studies have reported that statin drugs may reduce the risk of
Alzheimer's disease. More studies are being done to determine exactly what
role, if any, statins may have in Alzheimer's prevention. Researchers believe
that statins help improve blood flow to the brain by decreasing particles in
the blood such as cholesterol and triglycerides.

Selective estrogen receptor molecule (SERM): A drug called a
selective estrogen receptor molecule (SERM, including raloxifene or Evistaï¿½)
is used to protect against the bone loss associated with osteoporosis. It also
appears to lower the risk of developing mild cognitive impairment, a memory
disorder that often precedes Alzheimer's. The mechanism is unknown.

Ask the Expert

Delia Strondl is a Registered Career Counsellor focusing on both school readiness and career counselling. She achieved her honours in Psychology and completed a career counselling internship. Since then, she has been working with children with a variety of learning difficulties including ADHD and Cerebral Palsy. Read more

posted on 16-06-2015

posted on 15-06-2015

posted on 15-06-2015

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